| NPI | 1114025483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: IL 036-063788) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 336-028241) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2009-03-16 |